Summary of Work: The objective of this project was to evaluate the effectiveness and safety of pediatric procedures performed by adult critical care practitioners using the combination of ketamine and midazolam for anesthesia and sedation. Individuals from 1 to 18 years of age who had intravenous midazolarn sedation and ketamine anesthesia administered while undergoing lumbar puncture, bone biopsy, central venous catheter placement, liver biopsy, thoracentesis, or bone marrow aspirate/biopsy were identified. A retrospective chart review was performed. The dosages of medications used were tabulated, and mg/kg dosages were calculated. The procedures performed, their duration, and any complications of the anesthesia and sedation were noted. These complications included oxygen desaturations below 90%, vital sign alterations requiring intervention, rashes, subjective complaints of dizziness by the patient, and emergence reactions to ketamine. A total of 127 pediatric patients were admitted to the intensive care unit (ICU) sedation area for 295 procedures. All patients received ketamine and midazolam intravenously in divided doses and titrated to effect There were 9 complications observed. These included oxygen desaturation below 90% (n = 1), vital sign alterations requiring treatment (n = 3), rash (n = 2), dizziness (n = 1), wheezing (n = and emergence reaction (n = 1). No patient required admission to the ICU because of a complication. There were no episodes of bradycardia or other cardiopulmonary compromise. We conclude that pediatric anesthesia and sedation using ketamine and midazolam can be performed in a designated monitored setting, outside of the operating room, by experienced personnel, including non-pediatricians. This therapeutic combination allows painful procedures to proceed with less anxiety and pain. In experienced hands, a limited number of side effects were found to occur.